Provider Demographics
NPI:1902019086
Name:BLOCK, AMIE KEYS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMIE
Middle Name:KEYS
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HUDSON ST
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2103
Mailing Address - Country:US
Mailing Address - Phone:646-638-1701
Mailing Address - Fax:646-638-1703
Practice Address - Street 1:145 HUDSON ST
Practice Address - Street 2:SUITE 6B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2103
Practice Address - Country:US
Practice Address - Phone:646-638-1701
Practice Address - Fax:646-638-1703
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05443211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2574757OtherOXFORD
NY319110OtherMHN
NYNI0241Medicare ID - Type Unspecified